HLST 2040 – Lec 3

Health Informatics 1

Agenda for today• Finish Last week’s lecture• Look at Healthcare Information systems

• Define and Classify Information Systems • Information System Department

– Sections & Responsibilities & Roles – Technology Infrastructure – Business Environment

• Example of Information System • Healthcare Information System • –Elements of IS • –Needs of HIS • –Types of HIS

Last Week

• ADSS, CDSS

Quantitative Techniques

• Forecasting• Inventory models• Simulation• Linear Programming

Linear Programming

• Linear programming is generally used to determine the best consumption of resources in order to meet some objective. – In health care, these can be used to: Schedule staff

and use of facilities

– Design the optimal production of medical services or goods

– Establish the most efficient routes for transporting patients

– Determine the most efficient use of space

HR-ADSS

– Human resources management software typically supports the following functions:

– Recruitment and retention – Personnel administration – Management of payroll against budget – Training – Performance evaluation

• Management of compensation and benefits has become an increasingly complex task facilitated by decision support

Components of IS

Departments

• Operations• Telecommunications• Clinical applications• Administrative applications• Personal computer and help desk support• Systems administration• Network support

See pg. 133 of the text

Operations Responsibilities

• Operations– Maintenance of the information systems

hardware• Activities include production jobs, system

backups• Machine and printer maintenance• System backup to include:–Billing and patient data

Telecommunications

• Provides support for the telephone systems– Responsibilities include:• Adds, moves, and changes requested by users

– Managerial functions include:• Monitoring and verification of billing statements• Monitoring of switchboard

Systems Development/Project Management

• Develop small databases• Internet Web sites• Project management

Applications Support

• Requires information technology expertise and application domain expertise

• May be a challenge for the Hospital IS• Functionality – see top of pg. 134• Troubleshooting – document the problem and

contact the vendor• Enhancements- For example, enhance Lotus

Notes

Information Systems Support-pg. 135

• Help desk group– First response for problem solving– Lost passwords– Network outages– Help desk may use various software packages to enhance

its own efficiency• PC support section– Problem solving at the user’s desk, not creating tickets– Install new PCs– Reconfigure existing software

Network

• Primarily responsible for wiring that connects computers

• LAN (local area network)– Wiring within an organization

• WAN (wide area network)– Links a number of LANs owned by the organization

Systems Administration – pg. 136

• Responsible for management of the operating systems for all of the health care organization’s computers

• Security• Upgrades of operating systems• Resource management

• File management– Printing– Network communication– Tape management– Input function

CIO

• CIO Chief Information Officer • Has primary leadership role of IS department • Reports to CFO, COO, CEO • Qualification: master’s in health care

informatics, information sciences, computer sciences, business and many years experience

Director

• Responsibility for one or more sections– Responsible for telecommunications, networking,

systems management, operations• Manager – usually of a department• Supervisor – hands-on functions with staff• Operator – job within operations section

Other Information Systems Department Roles

• Telecom technicians and operators – support/switchboard management

• Systems analyst – application support/project management

• Consultant – contract basis– Selection and installation of applications– Development of Internet Web site

Technology Infrastructure Components

• Consists of hardware and software that enable all of the computations performed within an organization

• Primary components– Computers– Data communications network– Computer peripherals

Computers

• Computers perform the computational tasks required to process the information required by the health care organization

• Size, cost, and capacity may vary– Mainframe computers– Mid-range computers– Servers– Workstations– Portable computers and handheld devices

Mainframe Computers

• Range in cost from $300,000 to several million dollars

• Trend has been toward less expensive mid-range and mini-computers

• Sometimes required to run older applications (sometimes called legacy systems)

Mid-range Computers

• Price range from $50,000 to $300,000• Example of midrange is AS 400• Used to support the lab or radiology systems• Medium and smaller organizations are often able to

run their core software applications on these systems

Servers

• Low cost server systems range from $10,000 to $50,000

• More costly cost more• May be called by the nickname back-end• Computer networking technology allows such

systems to interact with each other

Workstations – pg. 141

• Supports both local and remote computing functions– Local computing• Word-processing• Spreadsheet functions

– Remote computing• Workstation access via the Internet

Portable Computers and Handheld Devices

• Allow staff to document patient care at point of care– Notebook computer on a movable stand

• Handheld computing devices to access health care information systems is emerging as a preferred mode of interaction– Blackberry or PDA at the bedside

Networks

• Information systems have primary responsibility for design, implementation, and maintenance of computer networks

• Example of growth is the Internet• Cloud computing is another big thing today – Concerns include:• Security and confidentiality• Misuse of the Internet• Provision of adequate bandwidth

Networks

• Hubs: connect devices in LAN• Routers and switches: link multiple LAN to

WAN and perform filtering of messages going from LAN to WAN

• Protocol- Language that the computers use to talk to each other over a network

Peripherals

• Computer peripherals are input and output devices used by computer systems– Printers– Magnetic tape devices– Computer terminals– Scanners– Projectors

Business Environment

• IT is always the “Bad Poster Boy” in a healthcare setting

• Reasons for failure– Immature technology – too early adopters?– Lack of alignment of objectives of the information

systems project with the overall organizational strategic objective

– Inadequate planning and transition management– Underestimation of resources and overestimation of

the benefits expected from the project

Business Environment

• Key contributors to success– The relationship the department has with its clients or

primary users (internal staff)– Leadership abilities to assemble “big picture” strategies

and an ability to keep up with ever-evolving technology

Types of Organization

• Community hospital– Typically supported using small or mid-range computer

systems

• Small doctor’s office– Use EMR and cloud computing

Types of Organization

• Teaching hospital– Many are research oriented and have contributed to

medical information systems advances• Example: HL7 standard• Critical care monitoring applications• Interface engine

HEALTH CARE INFORMATION SYSTEMS

Chapter 7

Objectives

• Discuss components of a Health care information system (HIS)

• Recognize six different types of HIS applications• Identify at least three constraints in the use of HIS

systems

Data ,Information, Knowledge• Data Input– User enters data – Transferred from other systems– Automatically captured from physiodynamic equipment

• Data Output– Aggregated data into information– Reports, Graphs, Screen displays

• Knowledge– Information combined with medical knowledge

• Various systems are used– For example, EMR,PACS

Healthcare Information Systems

• Classified in various ways• Easiest- Clinical or Administrative• Administartive- Staff scheduling, Finance, stock

and asset management etc.• All systems use one or more of:– UI– Network– Database– Output

2nd way of classifying HIS

• Institution-wide Systems • Specialty Support Systems • Documentation Systems • Administrative Systems • Operation Support Systems

Health Care Information System• Encompasses a wide array of applications( software)

and systems– Interfaced together– Supports and communicates required information

• Integration of systems– Unique to each organization

• Organizational strategic goals drive selection and prioritization of system selection

• Practice needs shape content and functionality• Business needs shape scope of information systems

plan

Example of use of IT systems• See pg. 149• Typical Ontario hospital has a mix of many large,

small, legacy and new systems• These can range from 50-200

Types of System Applications

• Institution wide– Admission, discharge, transfer (ADT)• Backbone of HIS system• Patient demographic information• Bed control

– Financial applications• Tracks financial interactions• Provides fiscal reporting• This kind of software is obviously not clinical• See pg. 153

Types of System Applications:

• Institution wide (continued)– Order entry applications• Regular clinical interaction• Order communication• Bill tracking• For example CPOE

– Results reporting• Separate from order entry• Multiple departments

Radiology Information System/ PACS

• Supports the operations of a radiology department

– File or X-ray tracking– X-ray scheduling– Radiology transport and patient tracking– Supports database of services that are provided by

department and billed against

• PACS– Filmless Xray– Fuji, GE , Toshiba

EMR

• eClinical works• http://www.eclinicalworks.com/Collateral/Flas

h/English-US/indexFLASH_popup.html

• Or• PS suite EMR• http://md.cma.ca/ps-suite/emr/

LIS

– Laboratory• Supports a laboratory department including machinery

that processes the lab specimens– Tracks and performs quality testing on lab

equipment– Tracks orders, specimen receipt, reorders,

processing, and results–Maintains the database to support normal result

ranges, specific test numbers, and suppliers

Pharmacy Systems

• Speciality system for the operations of a pharmacy department• Can be evaluated to support either inpatient or

outpatient services–Quality control for TPN mixtures–Order communication– Stock and reorder control–Narcotic counting and tracking– Drug reaction recording and tracking– Kroll is a big vendor of pharmacy systems

Documentation systems

– Available in a variety of formats• Communication of information real-time• Needs to support clinical workflow not distract

– Captures physiological data directly• Vital signs• Cardiac monitor• Others

Types of System Applications

• Administrative systems– Supports collection of data to manage a service line• Patient care services• Food services

– Case management systems– Acuity systems– Scheduling applications• Staff

– Patients

Types of System Applications

• Operations support systems– Addresses the day-to-day operations– Communication or paging systems– Human resource systems– Materials management

System Configurations

• Single vendor for majority of applications• Core vendor that systems must integrate with• Multiple systems: Best of breed

Vendors

• EMR - MD Physician Services (MD) owned by CMA

• GE –PACS• http://www.gehealthcare.com/euen/iis/produ

cts/radiology/pacs/pacs.html• Kroll• http://www.kroll.ca/software.html

Summary• Look at Healthcare Information systems• Define and Classify Information Systems • Information System Department

– Sections & Responsibilities & Roles – Technology Infrastructure – Business Environment

• Example of Information System • Healthcare Information System • –Elements of IS • –Needs of HIS • –Types of HIS